Renal Diseases Flashcards
What are the functions of the kidney?
- excretes waste substances
- acid-base balance
- Vit D activation
- blood pressure control
- red blood cell production
- regulate water balance
- regulates minerals in extracellular fluid
How do we measure kidney function?
- blood tests
- urine output
- elimination of radioisotopes
List some renal syndromes.
- asymptomatic proteinuria
- nephrotic syndrome
- haematuria
- acute kidney injury
- chronic kidney disease
Why is a kidney biopsy helpful?
- Provides a histological description that is compatible with a clinical condition
- May direct specific treatments.
Give some hypovolemic-related prerenal causes of kidney disease
Haemorrhage
Diarrhoea/ vomiting
Give some prerenal causes of kidney disease related to decreased perfusion.
Septic shock
Cardiac failure
Give some drug-related prerenal causes of kidney disease.
ACE inhibitors
Non-steroidal anti-inflammatory drugs
List some intrinsic renal diseases based on where they manifest.
GLOMERULAR:
- glomerulonephritis
TUBULAR:
- acute tubular necrosis
INTERSTITIAL:
- interstitial nephritis
What are some principles of glomerular disease?
- Whether it is primary or secondary, or if there’s a limited response to injury to the kidney
- Consider under headings of clinical syndrome, histopathology, and pathogenesis after taking personal, clinical and family history from patient
Why is glomerular disease a difficult subject?
- Often no good clinicopathological correlation
- Terminology is hard
- Ignorance of pathogenesis in many cases
What are the societal consequences of AKI?
- Significant impact on the outcome (hospital mortality/ post-discharge mortality)
- Drain on resources (length of stay in the ICU/ hospital referrals, tests, treatment, etc.)
- Affects patient morbidity (acute complications, dysfunction of other organs, risk of CKD)
How would you treat renal disease?
- General measures, such as dialysis, transplantation
- Psychosocial care
- Conservative management
- Identifying and treating the underlying condition.
Describe chronic renal management.
- conservative, with slow progression, to minimise symptoms and complication
- control Na+, water, BP
- regulate the diet (K+, phosphate, [protein])
→ IV Fe and erythropoeitin
What does dialysis achieve?
- removes nitrogenous wastes
- removes water
- corrects acid-base abnormalities
List the different types of deceased donors for transplantations.
Donors who died from cardiac death
Donors who were dead from ‘brain death’
List the different types of living donors for transplantations.
- Related donors (biological, emotional, social)
- Donors from kidney sharing schemes
- Altruistic donors
List the order of events that would occur in a hospital investigation if it was found that a patient may potentially have a low eGFR?
- Measure GFR
- Is there blood/protein in the urine?
- Is this intrinsic renal disease?
- Perform biopsy
- Provide general and specific treatments
- Manage consequences of poor eGFR (such as Vit D deficiency, lack of erythropoietin, dialysis, transplantation, conservative, etc.)
List the different ways in which we can measure kidney function, from the most accurate to the least accurate.
- Inulin (continuous infusion technique)
- Inulin (single bolus method), EDTA, iohexol
- 125l-iothalamate, DTPA
- 3-hour creatinine clearance with cimetidine
- estimated glomerular filtration rate (MDRD)
- serum creatinine
- 24-hour creatinine clearance
List some uremia-related cardiovascular risk factors.
- increased ECF volume
- calcification and calcium/phosphorus
- anaemia
- oxidant stress
- malnutrition
- pulse pressure
- triglycerides
- inflammation (C-reactive protein)
- sleep disorders
List some traditional coronary risk factors
- hypertension
- high LDL cholesterol
- smoking
- diabetes
- older age
- physical activity
- LVH (left ventricular hypertrophy)
What are the two forms of dialysis?
→ Haemodialysis
→ Peritoneal fluid
What is CKD a marker of?
→ cardiovascular risk
What are effects that indicate dialysis may be needed?
→ Oedema (pulmonary)
→ Hyperkalaemia
What is the first and second stage in AKI management?
FIRST:
→ Correct pre-renal factors
→ Relieve obstruction
SECOND
→ Maintain fluid and electrolyte balance
→ Nutrition
